Archive | 2021
COVID-19 during pregnancy. Analytical inspection
The cause of the current pandemic was the rapid spread of the coronavirus SARS-CoV-2 and the development of respiratory syndrome with significant morbidity and mortality. Pregnant women have the higher risk of morbidity and mortality than non-pregnant women. Pregnancy is the vulnerable condition that may contribute to a higher risk of infection due to the change in physiology during gestation. Physiologic, metabolic, and vascular changes in normal and high-risk pregnancies may affect risks for severe acute respiratory syndrome SARS-CoV-2 infection. The pathogenesis of COVID-19 during pregnancy explains the functioning of the renin-angiotensin-aldosterone system. SARS-CoV-2 uses angiotensin-converting enzyme-2 receptors to enter target cells. Its regulation during pregnancy may increase the risk of respiratory syndrome with COVID-19. The virus, by binding to receptors, causes decreasing its regulation and can lead to increasing angiotensin II, relative to angiotensin 1, 7, which is manifested by vasoconstriction and vascular dysfunction in preeclampsia. Coronavirus disease and preeclampsia have partially the same pathophysiological mechanism, which includes endothelial dysfunction and coagulation disorders. There is systemic inflammation or microcirculation disorders, which is characterized by vasoconstriction and ischemia, hypercoagulation. Thus, abnormalities that are characteristic of COVID-19 infection are similar to those that occur with preeclampsia during pregnancy. In addition, the known pathological mechanism of COVID-19 is an excessive anti-inflammatory response called the cytokine storm. The immune response is sufficiently altered during pregnancy, which can significantly alter the laboratory and clinical manifestations of COVID-19 during pregnancy. Therefore, the combination of these conditions can potentially lead to vascular damage. Currently, there are very limited data on the course, clinic and consequences of infection during pregnancy. This literature review combines various high-level studies that indicate higher rates of preeclampsia and other complications associated with pregnancy and SARS-CoV-2 infection. Studies to date have reported higher risks of pregnancy complications, including preterm birth and preeclampsia, as well as higher rates of cesarean delivery. For the fetus were recorded isolated cases of stillbirth, which was less than <1%. Accordingly, this signals needs to increase attention to the course of infection during pregnancy, and the optimal treatment of COVID-19, as well as prevention strategies during pregnancy. Pharmacologic therapy is limited to medications with proven safety during pregnancy and lactation. No conflict of interest was declared by the authors. Key words: COVID-19, pregnancy, newborns, pregnancy complications.